1295165710 NPI number — SUNWEST DENTAL CENTER IV, LLC

Table of content: (NPI 1295165710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295165710 NPI number — SUNWEST DENTAL CENTER IV, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNWEST DENTAL CENTER IV, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295165710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14557 W GRAND AVE STE B106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85374-7104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-374-3102
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14557 W GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-864-5558
Provider Business Practice Location Address Fax Number:
602-864-2451
Provider Enumeration Date:
11/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DALTON
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL MANAGER
Authorized Official Telephone Number:
623-680-3977

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D4013 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com